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What is this condition?

Acute pyelonephritis is a sudden inflammation of kidney tissues and is one of the most common kidney diseases. With treatment and continued follow-up care, most people get well, and extensive permanent tissue damage is rare.

What causes it?

Acute pyelonephritis is caused by bacterial infection of the kidneys. Those bacteria usually are normal intestinal and bowel organisms that grow readily in urine. The most common of them is Escherichia coli, but Pseudomonas aeruginosa, Staphylococcus aureus, and Strepto­coccus faecalis may also cause such infections.

In most people, the infection spreads from the bladder to the kidneys, where it can create colonies of infection within 24 to 48 hours. Infection may also be spread by hospital procedures such as catheterization, cystoscopy, or urologic surgery. The disorder may also result from blood-borne and lymphatic infections, as well as several kinds of urinary obstructions that make it difficult for the person to urinate.

Who gets the infection?

Pyelonephritis occurs more otten in women, probably because the urethra is shorter in women than in men, and because the urinary tract lies close to the vagina and the rectum. This allows bacteria to reach the bladder more easily. Women also lack certain antibacterial secretions men produce in this body region. Incidence increases with age and is higher in sexually active or pregnant women and in people with other kidney diseases or diabetes.

What are its symptoms?

The doctor will ask about such things as urgent, frequent or burning urination. The person’s urine may appear cloudy and have a fishy odor. Other common symptoms include a temperature of 102° F (38.8° C) or higher, shaking chills, flank pain, poor appetite, and general fatigue.

These symptoms can develop rapidly over a few hours or a few days. Although the symptoms may disappear within days, even without treatment, residual bacterial infection is likely and may cause symptoms to recur.

How is it diagnosed?

After learning about the person’s symptoms, the doctor will order a urinalysis. Typical findings include pus cells and, possibly, some red blood cells; significant numbers of bacteria; and a slightly alkaline urine pH.

A plain X-ray film of the kidneys, ureters, and bladder may reveal stones, tumors, or cysts in the kidneys and the urinary tract. X-rays with contrast dyes may reveal asymmetrical kidneys.

How is it treated?

The doctor will choose an antibiotic specifically designed to fight the persons infection. For example, E. coli may be treated with Gantrisin, NegGram, and Macrodantin or Furadantin. If the infecting organism can’t be identified, the doctor will prescribe a broad-spectrum antibiotic, such as Amcill. If the person is pregnant, the doctor will prescribe antibiotics with caution or urinary analgesics such as Phenazodine.

The person’s symptoms may disappear after several days of antibiotic therapy. Usually, the person takes antibiotics for 10 to 14 days. Follow-up testing includes a new urine culture 1 week after drug therapy stops, then periodically for the next year to catch any remain­ing infection.

Most people with uncomplicated infections respond well to ther­apy and don’t suffer reinfection. In infections resulting from an obstruction, antibiotics may be less effective, and the doctor may recommend corrective surgery. People who have a high risk of recurring urinary tract and kidney infections, such as those undergoing prolonged catheterization or maintenance antibiotic therapy, require long-term follow-up.

What can a person with acute pyelonephritis do?

If you are diagnosed with this kidney infection, here are some helpful suggestions:

  • Drink plenty of fluids to help empty your bladder of contaminated urine. However, don’t drink more than 3 quarts (3 liters) a day because this may reduce the effectiveness of the antibiotics you’re taking.
  • Follow the diet you are given to prevent kidney stone formation.
  • Complete prescribed antibiotic therapy, even after symptoms go away. Get long-term follow-up care if the doctor says you are at high-risk for more infections.
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